Provider Demographics
NPI:1962656678
Name:HEALTH SOURCE ONE PRIVATE DUTY & STAFFING, LLC
Entity Type:Organization
Organization Name:HEALTH SOURCE ONE PRIVATE DUTY & STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:JENKINS
Authorized Official - Last Name:SALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-293-7590
Mailing Address - Street 1:11715 BRICKSOME AVE
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2307
Mailing Address - Country:US
Mailing Address - Phone:225-293-7590
Mailing Address - Fax:
Practice Address - Street 1:11715 BRICKSOME AVE
Practice Address - Street 2:SUITE A-3
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2307
Practice Address - Country:US
Practice Address - Phone:225-293-7590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 6897251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care